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Structured pro-active care for chronic depression by practice nurses in primary care: a qualitative evaluation
Madeleine Bennett1, Kate Walters, Vari Drennan
1Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, London, United Kingdom.
Plos One
|September 27, 2013
Summary
Practice nurses providing proactive care reviews were found acceptable for patients with chronic depression. A strong therapeutic alliance between patients and nurses was key to successful management in primary care.
Area of Science:
- Mental Health Research
- Primary Care Nursing
- Qualitative Health Research
Background:
- Chronic and recurrent depression require ongoing management strategies.
- The ProCEED (Pro-active Care and its Evaluation for Enduring Depression) trial evaluated proactive care for enduring depression.
- This study focuses on the role of practice nurses in delivering this proactive care.
Purpose of the Study:
- To explore the impact and appropriateness of structured proactive care reviews by practice nurses for patients with chronic or recurrent depression.
- To understand patient and practice nurse perspectives on this model of care.
- To identify factors influencing the therapeutic alliance within this model.
Main Methods:
- Qualitative study involving in-depth interviews with 41 participants (26 patients, 15 practice nurses).
- Participants were part of the United Kingdom-wide ProCEED randomised controlled trial.
- Thematic analysis using a framework approach was applied to interview transcripts.
Main Results:
- Patients found practice nurses appropriate for discussing depression; nurses felt confident in case management.
- A therapeutic alliance between patient and nurse was crucial; its absence led to dissatisfaction for both.
- Factors influencing the therapeutic alliance and nurse typologies were identified.
Conclusions:
- Proactive care reviews by practice nurses are acceptable to most patients and nurses for long-term depression management in primary care.
- Motivated practice nurses can be a valuable resource for this patient group.
- Findings have implications for resource allocation decisions in primary care settings.
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